00:00
Hi. My name is Amy and I'm a pediatric nurse practitioner. So, we're going to be
talking about diabetes mellitus type 1and type 2 and how you can differentiate
between those 2. So, what is diabetes? I know that you probably hear a lot about
diabetes in your nursing program and this is a really complex topic. So, we're
going to go over some of the highlights of diabetes and talk about how this impacts
pediatric patients. So, type 1 diabetes mellitus is an absolute insulin deficiency.
00:39
This means that the pancreas does not produce insulin. So, in this slide you have
this picture, where on the left you have your pancreas and you can see that that
arrow indicates that you are not creating insulin in the pancreas and that goes
over toward the right side of your screen where you see a blood vessel that's
surrounding a cell. Now, normally you would want to see insulin going into the
blood vessel, hitting a receptor, and making all of that blood sugar that's in the
blood cell go in to the cell so the cell could use that for energy. In this case,
however, what you're noticing is that there's no insulin so there's no hormone on
able to move into the cell and the cell cannot use it for energy. So, this happens
usually due to autoimmune destruction of beta cells. The beta cells are the cells
in the pancreas that produce the insulin. Now in type 2 diabetes, we have some
variable degrees of insulin resistance and insulin deficiency. So, type 2 diabetic
patients do have some insulin, but it's definitely not working the way it should. In
this picture on the side, you'll notice that there is beta cells. They are producing
some insulin. You see in that arrow that insulin is moving over toward that blood
vessel and it is making its way to the receptor. But in this case, that receptor is
blocked or for some reason is not able to allow that blood sugar to move in to the
cell. There is a phenomenon called glucotoxicity. This often happens in type 2
diabetic patients and this can happen when you already have high blood sugar then
that high blood sugar really impairs the pancreas. It keeps that pancreas from
producing insulin and that just causes your blood sugar to go higher and higher.
02:37
So it's really kind of a nasty feedback loop where the glucose itself is keeping the
insulin from working as well as it should and you just get higher and higher blood
sugar. So, if you were to take a guess, do you think there are more cases of type 1
diabetes or type 2 diabetes? So it turns out that there are many more cases of type 2
diabetes. Approximately 90% of all diabetic patients are going to have type 2
diabetes. So, the remaining amount, around 5-10% of diabetic patients are going to
be type 1. Now, notice 5-10% doesn't completely get you to that 100% so there are
a few patients that are technically not going to be type 1 or type 2. The remainder
are caused by some very specific pathophysiologic factors that we are not going to
be covering in today's presentation. We're focusing on type 1 and type 2 diabetes.
03:46
So in children and adolescents, it is important to note that you are more often going to
see type 1 diabetes than type 2 diabetes. Type 2 has generally been considered
kind of an adult disease, although we are starting to see that happen more often in
adolescents. Cases of both types of diabetes are actually on the rise. We are not
entirely sure why this is the case in the instance of type 1 diabetes. For type 2
diabetes, cases are on the rise often because the rates of obesity and some other
risk factors that we'll discuss here in a moment are also on the rise. So, what can
cause diabetes? In the case of both type 1 and type 2 diabetes, you might have
some genetic susceptibility. Now, for type 1 in particular, there are certain things
that are going to make you more likely to develop a diagnosis of type 1 diabetes.
04:54
So, you can see that if both of your parents are affected, that blue bar is
much larger than if just your mother or just your father were affected. So if you
have no family history, for example, you only have about a 0.4% chance of
developing type 1 diabetes. If your mother is affected, you have a 1-4% chance.
05:15
If it's your father that's affected, a 3-8% chance. So if both of your parents are
affected as you noted that blue bar gets larger and your percentage risk jumps up
to 30%. If you have a sibling who is not a twin that has diabetes, then the risk is
3-6%. If you have a dizygotic twin, your chance is 8%; and a monozygotic twin,
your chance jumps up to 30%. So if there are identical twins, you're going to have
a higher risk for type 1 diabetes. So what about type 2 diabetes? There are some
risk factors for type 2 diabetes as well that are not quite as related to some of these
genetic factors and they include obesity. There are certain ethnicities that are at
higher risk for type 2 diabetes, age, and pubertal status. So older adults are more
likely to have type 2 diabetes and post pubertal people are more likely to develop
type 2 diabetes, and your sex. So, what are symptoms of diabetes and how do we